• Critical care nurse · Dec 2023

    Using a Fluid Resuscitation Algorithm to Reduce the Incidence of Abdominal Compartment Syndrome in the Burn Intensive Care Unit.

    • Jasmine Peters, Paul Won, Julie Herrera, T Justin Gillenwater, and Haig A Yenikomshian.
    • Jasmine Peters is a plastic surgery resident, University of Wisconsin School of Medicine and Public Health, Division of Plastic and Reconstructive Surgery, Madison.
    • Crit Care Nurse. 2023 Dec 1; 43 (6): 586658-66.

    BackgroundPatients with large burns must be carefully resuscitated to balance adequate tissue perfusion with the risk of end-organ damage. One devastating complication of overresuscitation is abdominal compartment syndrome. Reducing the volume of fluids given during resuscitation may reduce the incidence of abdominal compartment syndrome and improve outcomes.ObjectiveTo determine whether decreasing fluid resuscitation volume in a burn center reduced the incidence of abdominal compartment syndrome.MethodsThis retrospective cohort study involved all patients with severe burns (total body surface area ≥20%) who were admitted to a burn intensive care unit over 4 years (n = 166). Primary outcomes were required fluid volume, whether differences in the patient characteristics measured affected outcomes, rate of abdominal compartment syndrome, and incidence of abdominal hypertension. After the first 2 years, the Parkland fluid resuscitation algorithm was modified to decrease the volume goal, and patients were assessed for the incidence of abdominal compartment syndrome and related complications such as kidney failure, abdominal hypertension, and ventilator days.ResultsA total of 16% of patients resuscitated using the Parkland equation experienced abdominal compartment syndrome compared with 10% of patients resuscitated using the modified algorithm, a difference of 6 percentage points (P = .39). Average volume administered was 11.8 L using the Parkland formula and 9.4 L using the modified algorithm (P = .03).ConclusionDespite a significant decrease in the amount of fluid administered, no significant difference was found in incidence of abdominal compartment syndrome or urine output. Matched prospective studies are needed to improve resuscitation care for patients with large burns.©2023 American Association of Critical-Care Nurses.

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